Long-Term Analysis of NRG Oncology RTOG 0415: A Randomized Phase III Noninferiority Study Comparing Two Fractionation Schedules in Patients With Low-Risk Prostate Cancer.

JCO NRG Oncology RTOG 0415 is a randomized phase III noninferiority (NI) clinical trial comparing conventional fractionation (73.8 Gy in 41 fractions) radiotherapy (C-RT) with hypofractionation (H-RT; 70 Gy in 28) in patients with low-risk prostate cancer. The study included 1,092 protocol-eligible patients initially reported in 2016 with a median follow-up of 5.

Intraoral Neuromuscular Stimulation Device and Rapid Eye Movement-Dependent Obstructive Sleep Apnea.

Obstructive sleep apnea (OSA) is a sleep breathing disorder characterized by recurrent pharyngeal collapse secondary to the decreased tone of the pharyngeal dilator muscles. The genioglossus muscle is a major pharyngeal dilator responsible for maintaining the upper airway. Research has shown that patients with OSA have a stronger but less endurant genioglossus muscle.

Fall, Fracture, and Two Episodes of Euglycemic Diabetic Ketoacidosis.

Diabetic ketoacidosis (DKA) is a serious diabetic complication that is characterized by hyperglycemia, metabolic acidosis, and ketosis. A subset of DKA patients may present with blood glucose levels <250 mg/dL which may delay the diagnosis. This subset is referred to as euglycemic DKA (euDKA).

Anterior Cervical Discectomy and Fusion: A Hidden Etiology of Obstructive Sleep Apnea.

Obstructive Sleep Apnea (OSA), a common variant of sleep-disordered breathing, is characterized by repeated complete or partial collapse of upper airways during sleep, leading to oxyhemoglobin desaturations. The obstruction may be iatrogenically induced in patients undergoing Anterior Cervical Discectomy and Fusion (ACDF). Damage to the pharyngeal plexus during the procedure may predispose to a new collapse of the upper airway, and the placement of the hardware for the fusion may lead to further narrowing of the upper airway.

Hidden Dangers of Severe Obstructive Sleep Apnea.

Obstructive sleep apnea (OSA) is a breathing disorder secondary to collapsing upper airways while sleeping. The collapse leads to a significant decrease or a complete cessation of airflow despite an ongoing effort to breathe. OSA leads to poor sleep quantity and quality, which, in turn, causes temporary cognitive impairments.

Tramadol Induced Jerks.

Myoclonus is a sudden, involuntary jerking of a muscle or a group of muscles. Myoclonus may present in form of a pattern or, sporadically and infrequently. It is usually associated with neurological disorders such as epilepsy, multiple sclerosis or infections, and tumors of the central nervous system.

Paradoxical Insomnia in a Frustrated Patient Treated With Hypnotics for Ten Years.

Insomnia remains a common complaint for which patients present to their primary care providers. The reflex response by most primary care providers to treat insomnia is by prescribing hypnotics. The most commonly prescribed hypnotic is a sedative, such as a benzodiazepine or a benzodiazepine receptor agonist (BRZA).

The Temple Vie weight management and lifestyle programme: initial data and reflections on Covid-19.

During the first three months of the Temple Vie programme, average weight loss in 36 subjects exceeded 13 kg. There were associated improvements in Patient Reported Outcome Measures, blood pressure and serum lipids. The Covid-19 pandemic may focus attention on programmes that give rise to rapid weight loss and improvements in cardiovascular health parameters.

ASPP2 inhibits tumor growth by repressing the mevalonate pathway in hepatocellular carcinoma.

Cancer is, fundamentally, a disorder of cell growth and proliferation, which requires adequate supplies of energy and nutrients. In this study, we report that the haplo-insufficient tumor suppressor ASPP2, a p53 activator, negatively regulates the mevalonate pathway to mediate its inhibitory effect on tumor growth in hepatocellular carcinoma (HCC). Gene expression profile analysis revealed that the expression of key enzymes in the mevalonate pathway were increased when ASPP2 was downregulated.

Obesity-Induced Methylation of Osteopontin Contributes to Adipogenic Differentiation of Adipose-Derived Mesenchymal Stem Cells.

Obesity is a major risk factor for many chronic diseases, including diabetes, fatty livers, and cancer. Expansion of the adipose mass has been shown to be related to adipogenic differentiation of adipose-derived mesenchymal stem cells (ASCs). However, the underlying mechanism of this effect has yet to be elucidated.

Surgical management of the recurrent laryngeal nerve in thyroidectomy: American Head and Neck Society Consensus Statement.

"I have noticed in operations of this kind, which I have seen performed by others upon the living, and in a number of excisions, which I have myself performed on the dead body, that most of the difficulty in the separation of the tumor has occurred in the region of these ligaments…. This difficulty, I believe, to be a very frequent source of that accident, which so commonly occurs in removal of goiter, I mean division of the recurrent laryngeal nerve." Sir James Berry (1887).

Radiobiological evaluation of prostate cancer IMRT and conformal-RT plans using different treatment protocols.

The purpose of this study is to evaluate the clinical efficacy of both step-and-shoot IMRT and 3D-Conformal Radiation Therapy modalities (CRT) in treating prostate cancer using radiobiological measures. Another aim was to estimate the risks for developing secondary malignancies in bladder and rectum due to radiotherapy from the corresponding modalities. The treatment plans of ten prostate cancer patients were developed using IMRT and CRT.

Randomized Phase III Noninferiority Study Comparing Two Radiotherapy Fractionation Schedules in Patients With Low-Risk Prostate Cancer.

Purpose: Conventional radiotherapy (C-RT) treatment schedules for patients with prostate cancer typically require 40 to 45 treatments that take place from > 8 to 9 weeks. Preclinical and clinical research suggest that hypofractionation-fewer treatments but at a higher dose per treatment-may produce similar outcomes. This trial was designed to assess whether the efficacy of a hypofractionated radiotherapy (H-RT) treatment schedule is no worse than a C-RT schedule in men with low-risk prostate cancer.

Temporary left ventricular assist device through an axillary access is a promising approach to improve outcomes in refractory cardiogenic shock patients.

Cardiogenic shock (CS) causes significant morbidity and mortality and such patients can deteriorate rapidly. Temporary left ventricular assist devices (LVADs) are a promising approach to manage these patients. The following is a case series in which patients stabilized with a temporary LVAD for CS improvement were analyzed retrospectively.

Mini right thoracotomy as an approach to aortic valve closure in an assist device patient.

This case report concerns a patient status post left ventricular assist device placement that was complicated by new onset severe aortic valve insufficiency. After almost 2 years with his device, the patient had a syncopal episode and had worsening aortic valve regurgitation on echocardiography. The patient underwent an aortic valve closure via the right second intercostal space, which represents a new approach to managing these patients surgically and avoiding repeat sternotomies and further right ventricle injury.

Reduction in radiation (fluoroscopy) while maintaining safe placement of pedicle screws during lumbar spine fusion.

Study Design: Prospective, randomized, controlled study.

Objective: To report the results of using the PediGuard (SpineGuard, Inc., San Francisco, CA), a local electrical conductivity measurement device, to reduce radiation exposure while drilling the pilot hole for pedicle screw placement.